Search results for: psychotherapeutic outcome

Authors: Rigas Dimakopoulos, Marianna Papadopoulou, Roser Pons

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Background: Participation in family, recreational activities and self-care is an integral part of health. It is also the main outcome of rehabilitation services for children and adolescents with motor disabilities. There are currently no tools in Greek to assess participation in young children. Purpose: To culturally adapt and validate the Greek version of the Child Engagement in Daily Living (CEDL). Method: The CEDL was cross-culturally translated into Greek using forward-backward translation, review by the expert committee, pretest application and final review. Internal consistency was evaluated using the Cronbach alpha and test-retest reliability using the intra-class correlation coefficient (ICC). Parents of children aged 18 months to 5 years and with motor disabilities were recruited. Participants completed the CEDL and the children’s gross motor function was classified using the Gross Motor Function Classification System (GMFCS). Results: Eighty-three children were included, GMFCS I-V. Mean ± standard deviation of the CEDL domains “frequency of participation” “enjoyment of participation” and “self-care” were 58.4±14.0, 3.8±1.0 and 49.9±24, respectively. Internal consistency of all domains was high; Cronbach alpha for “frequency of participation” was 0.83, for “enjoyment of participation” was 0.76 and for “self-care” was 0.92. Test-retest reliability (ICC) was excellent for the “self-care” (0.95) and good for “frequency of participation” and “enjoyment of participation” domains (0.90 and 0.88, respectively). Conclusion: The Greek CEDL has good reliability. It can be used to evaluate participation in Greek young children with motor disabilities GMFCS levels I-V.

Keywords: participation, child, disabilities, child engagement in daily living

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Authors: Christoph Schuler, Oriana Ponta

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Public Financial Management (PFM) reforms are promoted by various international organizations such as the International Monetary Fund (IMF) or the World Bank, local development banks and the donor country community to strengthen governance and accountability in developing countries across the world. Reform efforts undertaken are often systematically measured against international best practice by the application of standardized analytical instruments such as the Public Expenditure and Financial Accountability Framework (PEFA) or the Poverty Reduction Action Plan (PARP). While those instruments analyze direct achievements of PFM reforms, the long-term benefits of such reforms for society remain untapped. This gives rise to the question why the concept of impact evaluation with its experimental or quasi-experimental settings in the form of randomized control trials has rarely been applied in the context of PFM reforms. To close this gap, this study provides examples where the concept of impact evaluation can be applied to PFM reforms and thereby shifting the focus from outcome towards a long-term impact. As it is a new approach, this study does not attempt to conduct a fully flagged impact evaluation of a certain PFM reform. However, it will outline, as a form of pre-test the applicability of the impact evaluation methodology in this context, for example, by more closely analyzing the commonly used indicators (for example within PEFA or PARP). This would mean to scrutinize these indicators as to how they were designed and how they are related to the long-term impact, they should be producing. The analysis of PFM reform indicators and their relation to long-term impacts should provide practitioners and scholars alike with new insights on how to strengthen the accountability of public service delivery through successful and sustainable PFM reforms.

Keywords: accountability, impact evaluation, PFM reforms, public financial management

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Authors: Ge Sun, Monika Trzpis, Robbert J. de Haas, Paul M. A. Broens

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Introduction: Dynamic magnetic resonance defecography is frequently used to assess defecation disorders. We aimed to investigate the usefulness of dynamic magnetic resonance defecography for assessing the severity of defecation disorder. Methods: We included patients retrospectively from our tertiary referral hospital who had undergone dynamic magnetic resonance defecography, anorectal manometry, and anal electrical sensitivity tests to assess defecation disorders between 2014 and 2020. The primary outcome was the association between the dynamic magnetic resonance defecography variables and the severity of defecation disorders. We assessed the severity of fecal incontinence and constipation with the Wexner incontinence and Agachan constipation scores. Results: Out of the 32 patients included, 24 completed the defecation questionnaire. During defecation, the M line length at magnetic resonance correlated with the Agachan score (r = 0.45, p = 0.03) and was associated with anal sphincter pressure (r=0.39, p=0.03) just before defecation. During rest and squeezing, the H line length at imaging correlated with the Wexner incontinence score (r=0.49, p=0.01 and r=0.69, p< 0.001, respectively). H line length also correlated positively with the anal electrical sensation threshold during squeezing (r=0.50, p=0.004) and during rest (r= 0.42, p=0.02). Conclusions: The M and H line lengths at dynamic magnetic resonance defecography can be used to assess the severity of constipation and fecal incontinence respectively and reflect anatomic changes of the pelvic floor. However, as these anatomic changes are generally late-stage and irreversible, anal manometry seems a better diagnostic approach to assess early and potentially reversible changes in patients with defecation disorders.

Keywords: defecation disorders, dynamic magnetic resonance defecography, anorectal manometry, anal electrical sensitivity tests, H line, M line

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Authors: Chuks Odiegwu-Enwerem

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The classical notion of opinion leadership presupposes that the media is at the center of an effective and successful opinion leadership. Under this idea, an opinion leader is an active media user who consumes, understands, digests and interprets the messages for the understanding and acceptance/adoption by lower-end media users – whose access and understanding of media content are supposedly low. Because of their unique access to and presumed understanding of media functions and their content, opinion leaders are typically esteemed by those who look forward to and accept their opinions. Lazarsfeld and Katz’s two-step flow of communication theory is the basis of opinion leadership – propelled by limited access to the media. With the emergence and spread of social media and its unlimited access by all and sundry, however, the study interrogates the relevance and application of opinion leaders and, by implication, the two-step flow communication theory in Nigeria’s Northcentral region. It seeks to determine whether opinion leaders still exist in the picture and if they still exert considerable influence, especially in matters of political conversations and decision-making among the citizens of this area. It further explores whether the diffusion of social media is a reality and how the ‘low-end’ media users react to the new-found freedom of access to media, and how they are using it to inform their decisions on important matters as well as examines if they are still glued to their opinion leaders. This study explores the empirical dimensions of the two-step flow hypothesis in relation to the activities of social media to determine if a change has occurred and in what direction, using mixed methos of Survey and in-depth interviews. Our understanding and belief in some theoretical assumptions may be enhanced or challenged by the study outcome.

Keywords: Opinion Leadership, Active Media User, Two-Step-Flow, Social media, Northcentral Nigeria

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Authors: Marina E. Konstantinidi

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It is now well-established that the fight against climate change and its consequences, which are a threat to mankind and to life on the planet Earth, requires that global temperature rise be kept under 1,5°C. It is also well-established that this requires humanity to put an end to the use of fossil fuels in the next decades, at the latest. However, investors in the fossil energy sector have brought or threatened to bring investment arbitration claims against States which put an end to their activity for the purpose of reaching their climate change policies’ objectives. Examples of such claims are provided by the cases of WMH v. Canada, Lone Pine v. Canada, Uniper v. Netherlands and RWE v. Netherlands. Irrespective of the outcome of the arbitration proceedings, the risk of being ordered to pay very substantial damages may have a ‘chilling effect’ on States, meaning that they may hesitate to implement the energy transition measures needed to fight climate change and its consequences. Although mitigation action is a relatively recent phenomenon, knowledge about the negative impact of fossil fuels has existed for a long time ago. In this paper, it is argued that structured documentation of evidence of knowledge about climate change may influence the adjudication of investment treaty claims and, consequently, affect the content of energy transition regulations that will be implemented. For example, as concerns investors, evidence that change in the regulatory framework towards environmental protection could have been predicted would refute the argument concerning legitimate expectations for legislative stability. By reference to relevant case law, it attempted to explore how pre-existing knowledge about climate change can be used in the adjudication of investor-State disputes and resulting from green energy transition policies.

Keywords: climate change, energy transition, international investment law, knowledge

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Authors: Yusha'u Shu'aibu Baraya, Kah Keng Wong, Nik Soriani Yaacob

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Strobilanthes crispus (S. crispus), is a Malaysian herb locally known as ‘Pecah kaca’ or ‘Jin batu’ which have demonstrated potent anticancer effects in both in vitro and in vivo models. In particular, S. crispus subfraction (SCS) significantly reduced tumor growth in N-methyl-N-Nitrosourea-induced breast cancer rat model. However, there is paucity of information on the effects of SCS in breast cancer metastasis. Thus, in this study, the antimetastatic effects of SCS (100 mg/kg) was investigated following 30 days of treatment in 4T1-induced mammary tumor (n = 5) model. The response to treatment was assessed based on the outcome of the tumour growth, body weight and hematological parameters. The results demonstrated that tumor bearing mice treated with SCS (TM-S) had significant (p<0.05) reduction in the mean tumor number and tumor volume as well as tumor weight compared to the tumor bearing mice (TM), i.e. tumor untreated group. Also, there was no secondary tumor formation or tumor-associated lesions in the major organs of TM-S compared to the TM group. Similarly, comparable body weights were observed among the TM-S, normal (uninduced) mice treated with SCS and normal (untreated/control) mice (NM) groups compared to the TM group (p<0.05). Furthermore, SCS administration does not cause significant changes in the hematological parameters as compared to the NM group, which indicates no sign of anemia and toxicity related effects. In conclusion, SCS significantly inhibited the overall tumor growth and metastasis in 4T1-induced breast cancer mouse model suggesting its promising potentials as therapeutic agent for breast cancer treatment.

Keywords: 4T1-cells, breast cancer, metastasis, Strobilanthes crispus

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Authors: John Abish, Bibin John

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Liquid-liquid flow in horizontal pipe is investigated in order to reveal the flow patterns arising from the co-existed flow of oil and water. The main focus of the study is to identify the feasibility of reducing the pumping power requirements of petroleum transportation lines by having an annular flow of water around the thick oil core. This idea makes oil transportation cheaper and easier. The present study uses computational fluid dynamics techniques to model oil-water flows with liquids of similar density and varying viscosity. The simulation of the flow is conducted using commercial package Ansys Fluent. Flow domain modeling and grid generation accomplished through ICEM CFD. The horizontal pipe is modeled with two different inlets and meshed with O-Grid mesh. The standard k-ε turbulence scheme along with the volume of fluid (VOF) multiphase modeling method is used to simulate the oil-water flow. Transient flow simulations carried out for a total period of 30s showed significant reduction in pressure drop while employing core annular flow concept. This study also reveals the effect of viscosity ratio, mass flow rates of individual fluids and ration of superficial velocities on the pressure drop across the pipe length. Contours of velocity and volume fractions are employed along with pressure predictions to assess the effectiveness of this proposed concept quantitatively as well as qualitatively. The outcome of the present study is found to be very relevant for the petrochemical industries.

Keywords: computational fluid dynamics, core-annular flows, frictional flow resistance, oil transportation, pressure drop

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Authors: M. Afzal, Salem Safer Alghamdi, Awais Ahmad

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Limited amount of irrigation water is an alarming threat to arid and semiarid agriculture. However, genotypic response differences to water deficit conditions within species have been reported frequently. Present study was conducted in order to measure the genotypic differences among faba bean accessions under Regular Deficit Irrigation (RDI). Five seeds from each accession were sown in 135 silt filled pots (30 x 24 cm). Experiment was planned under split plot arrangement and replicated thrice. Treatments consisted of three RDI levels (100% (control), 60% and 40% of the field capacity) and fifteen faba bean accessions (two local accessions as reference while thirteen from different sources around the world). Irrigation treatment was started from the very first day of sowing. Plant height, shoot dry weight, stomatal conductance and total chlorophyll contents (SPAD reading) were measured one month after germination. Irrigation, faba bean accessions and the all possible interactions has stood significantly high for all studied parameters. Regular deficient irrigation has hampered the plant growth and associated parameters in decreasing order (100% < 60% < 40%). Accessions have responded differently under regular deficient irrigation and some of them are even better than local accession. A highly significant correlation among all parameters has also been observed. It was concluded from results that above parameters could be used as markers to identify the genotypic differences for water deficit stress response. This outcome encouraged the use of superior faba bean genotypes in breeding programs for improved varieties to enhance water use efficiency under stress conditions.

Keywords: accessions, stomatal conductance, total chlorophyll contents, RDI, regular deficient irrigation

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Authors: Kamel Abd Elaziz Mohamed, Ahmed Yehia Mousa, Ahmed Samir ElSawy, Adel Mohamed Saleem

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Introduction: Critically ill patients frequently require tracheostomy to simplify long term air way management. While tracheostomy indications have remained unchanged, the timing of elective tracheostomy for the ventilated patient has been questioned. Aim of the work: This study was performed to compare the differences between early and late percutaneous dilatational tracheostomy (PDT) regarding, mechanical ventilation duration (MVD), length of ICU stay, length of hospital stay, incidence of ventilator associated pneumonia and hospital outcome. Patients and methods: Forty patients who met the inclusion criteria were randomly divided into early PDT who had the tracheostomy within the first 10 days of mechanical ventilation (MV) and the late PDT who had the tracheostomy after 10 days of MV. On admission, demographic data and Acute Physiology and Chronic ill Health II and GCS were collected. The duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS were all calculated. Results: Total of 40 patients were randomized to either early PDT (n= 20) or late PDT (n= 20). There were no significant differences between both groups regarding demographic data or the scores: APACHE II (22.75± 7 vs 24.35 ± 8) and GCS (6.10 ±2 vs 7.10 ± 2.71). An early PDT showed fewer complications vs late procedure, however it was insignificant. There were significant differences between the two groups regarding mean (MVD) which was shorter in early PDT than the late PDT group (32.2± 10.5) vs (20.6 ± 13 days; p= 0.004). Mean ICU stay was shorter in early PDT than late PDT (21 .0± 513.4) vs (40.15 ±12.7 days; p 6 0.001). Mean hospital stay was shorter in early PDT than late PDT (34.60± 18.37) vs (55.60± 25.73 days; p=0.005). Patients with early PDT suffered less sepsis and VAP than late PDT, there was no difference regarding the mortality rate between the two groups. Conclusion: Early PDT is recommended for patients who require prolonged tracheal intubation in the ICU as outcomes like the duration of mechanical ventilation length of ICU stay and hospital stay were significantly shorter in early tracheostomy.

Keywords: intensive care unit, early PDT, late PDT, intubation

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Authors: Nuzhat Sultana M. B.

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Children are high-risk population in terms of food born illnesses. Food safety and security are the most important aspect of the success of midday meal programmes. Improper holding temperatures, cross-contamination and poor personal hygiene of food handlers are the main causes for the prevalence of pathogenic microbes in the food servicing areas. Two hundred and fifty preschool children in the age of 3 to 6 years from urban and rural anganwadies (pre school center) of Beed district were selected. Nutritional status of preschool children were assessed by anthropometrical and clinical measurement. The study assessed the food safety and security with the help of personal hygiene and other safety measures maintained by the food personnel working for midday meal programme, supplying mid meals to children in govt. anganwadies (pre school center). The hygiene level, sanitary condition and microbial quality of food and water, pathological health examination of food handlers were assessed with the help of checklist. A questionnaire was designed to evaluate knowledge, attitude, and practices of food handlers. Results of the study show that the nutritional and health status of rural and urban preschool children was very poor. Many of the food handlers were not aware of general knowledge and hygiene practices to be followed during food preparation areas. An intervention programme of education and importing training at workplaces has shown a positive impact on the outcome of safety and security practices and safe, hygienic practices of food handlers at workplace.

Keywords: food, health, preschool children, safety, security

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Authors: Rajandeep Kaur, Rajeev Gupta

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Background: Chronic myeloid leukemia (CML) is the most common leukaemia in India. The annual incidence of chronic myeloid leukemia in India was originally reported to be 0.8 to 2.2 per 1,00,000 population. CML is a clonal disorder that is usually easily diagnosed because the leukemic cells of more than 95% of patients have a distinctive cytogenetic abnormality, the Philadelphia chromosome (Ph1). The approval of tyrosine kinase inhibitors (TKIs), which target BCR-ABL1 kinase activity, has significantly reduced the mortality rate associated with chronic myeloid leukemia (CML) and revolutionized treatment. Material and Methods: 80 diagnosed cases of CML were taken. Investigations were done. Bone marrow and molecular studies were also done and with EUTOS, patients were stratified into low and high-risk groups and then treatment with Imatinib was given to all patients and the molecular response was evaluated at 6 months and 12 months follow up with BCR-ABL by RT-PCR quantitative assay. Results: In the study population, out of 80 patients in the study population, 40 were females and 40 were males, with M: F is 1:1. Out of total 80 patients’ maximum patients (54) were in 31-60 years age group. Our study showed a most common symptom of presentation is abdominal discomfort followed by fever. Out of the total 80 patients, 25 (31.3%) patients had high EUTOS scores and 55 (68.8%) patients had low EUTOS scores. On 6 months follow up 36.3% of patients had Complete Molecular Response, 16.3% of patients had Major Molecular Response and 47.5% of patients had No Molecular Response but on 12 months follow up 71.3% of patients had Complete Molecular Response, 16.25% of patients had Major Molecular Response and 12.5% patients had No Molecular Response. Conclusion: In this study, we found a significant correlation between EUTOS score and Molecular response at 6 months and 12 months follow up after Imatinib therapy.

Keywords: chronic myeloid leukemia, European treatment and outcome study score, hematological response, molecular response, tyrosine kinase inhibitor

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Authors: Zanib Nafees, Amir Razaghizad, Ibtisam Mahmoud, Abhinav Sharma, Renzo Cecere

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More than one million surgeries are performed each year in Canada, resulting in more than 100,000 associated serious adverse events (SAEs) per year. These are defined as unintended injuries or complications that adversely affect the well-being of patients. In recent years, there has been a proliferation of digital health interventions that have the potential to assist, monitor, and educate patients—facilitating self-care following post-operative discharge. Among digital health, interventions are interactive-voice response technologies (IVRs), which have been shown to be highly effective in certain medical settings. Although numerous IVR-based interventions have been developed, their effectiveness and utility remain unclear, notably in post-operative settings. To the best of our knowledge, no systematic or scoping reviews have evaluated this topic to date. Thus, the objective of this scoping review protocol is to systematically map and explore the literature and evidence describing and examining IVR tools, implementation, evaluation, outcome, and experience for post-operative patients. The focus will be primarily on the evaluation of baseline performance status, clinical assessment, treatment outcomes, and patient management, including self-management and self-monitoring. The objective of this scoping review is to assess the extent of the literature to direct future research efforts by identifying gaps and limitations in the literature and to highlight relevant determinants of positive outcomes in the emerging field of IVR monitoring for health outcomes in post-operative patients.

Keywords: digital healthcare technologies, post-surgery, interactive voice technology, interactive voice response

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Authors: Marzieh Imani

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Antoni Gaudi and Santiago Calatrava have reputation for designing bio-inspired creative and technical buildings. Even though they have followed different independent approaches towards design, the source of bio-inspiration seems to be common. Taking a closer look at their projects reveals that Calatrava has been influenced by Gaudi in terms of interpreting nature and applying natural principles into the design process. This research firstly discusses the dialogue between Biomimicry and architecture. This review also explores human/nature discourse during the history by focusing on how nature revealed itself to the fine arts. This is explained by introducing naturalism and romantic style in architecture as the outcome of designers’ inclination towards nature. Reviewing the literature, theoretical background and practical illustration of nature have been included. The most dominant practical aspects of imitating nature are form and function. Nature has been reflected in architectural science resulted in shaping different architectural styles such as organic, green, sustainable, bionic, and biomorphic. By defining a set of common aspects of Gaudi and Calatrava‘s design approach and by considering biomimetic design categories (organism, ecosystem, and behaviour as the main division and form, function, process, material, and construction as subdivisions), Gaudi’s and Calatrava’s project have been analysed. This analysis explores if their design approaches are equivalent or different. Based on this analysis, Gaudi’s architecture can be recognised as biomorphic while Calatrava’s projects are literally biomimetic. Referring to these architects, this review suggests a new set of principles by which a bio-inspired project can be determined either biomorphic or biomimetic.

Keywords: biomimicry, Calatrava, Gaudi, nature

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Authors: Vignesh Ratnaraj, Jaewon Chang

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Background: Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta-analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients. Methods: PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and “normal” gait speed. The primary outcome was in-hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay. Results: There were seven eligible studies with 36,697 patients. Slow gait speed was associated with an increased likelihood of in-hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87–2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38–1.66), AKI (RR: 2.81; 95% CI: 1.44–5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59–1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48–2.63), reoperation (RR: 1.38; 95% CI: 1.05–1.82), institutional discharge (RR: 2.08; 95% CI: 1.61–2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32–26.05). Conclusion: Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than non-frail counterparts and are at an increased risk of developing various perioperative complications.

Keywords: cardiac surgery, gait speed, recovery, frailty

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Authors: I. Hua Chu, Hsiang-Chi Yu, Hsuan Su

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Purpose: To examine the associations between self-determined motivation and physical activity in patients with coronary heart disease (CHD) in a longitudinal study. Methods: Patients with CHD were recruited for this study. Their motivations for exercise were measured by the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2). Physical activity was assessed using the 7-day physical activity recall questionnaire. Duration and energy expenditure of moderate to vigorous physical activity (MVPA) were used in data analysis. All outcome measures were assessed at baseline and 12 months follow up. Data were analyzed using Pearson correlation analysis and regression analysis. Results: The results of the 45 participants (mean age 60.24 yr; 90.2% male) revealed that there were significant negative correlations between amotivation at baseline and duration (r=-.295, p=.049) and energy expenditure (r=-.300, p=.045) of MVPA at 12 months. In contrast, there were significant positive correlations between calculated relative autonomy index (RAI) at baseline and duration (r=.377, p=.011) and energy expenditure (r=.382, p=.010) of MVPA at 12 months. There was no significant correlation between other subscales of the BREQ-2 and duration or energy expenditure of MVPA. Regression analyses revealed that RAI was a significant predictor of duration (p=.011) and energy expenditure (p=.010) of MVPA at 12 months follow-up. Conclusions: These results suggest that the relative degree of self-determined motivation could predict long-term MVPA behaviors in CHD patients. Physical activity interventions are recommended to target enhancing one’s identified and intrinsic motivation to increase the likelihood of physical activity participation in this population.

Keywords: self-determined motivation, physical activity, coronary heart disease, relative autonomy index (RAI)

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Authors: Vahid Mazloum, Mansour Sahebozamani, Amirhossein Barati, Nouzar Nakhaee, Pouya Rabiei

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Non-specific chronic low back pain (NSCLBP) is a common condition with no exact diagnosis and mechanism for its occurrence. Recently, different therapeutic exercises have taken into account to manage NSCLBP. So, the aim of this study has mainly been placed on comparing the effects of Pilates and Mackenzie exercises on quality of life (QOL) lumbar spine position sense (LSPS) in patients with NSCLBP. In this randomized clinical trial, 47 patients with NSCLBP were voluntarily divided into three groups of Pilates (n=16) (with mean age 37.1 ± 9.5 years, height 168.9 ± 7.4 cm, body mass 76.1 ± 5.9 k), McKenzie (n=15) (with mean age 42.7 ± 8.1 years, height 165.7 ± 6.8, body mass 74.1 ± 4.8 kg) and control (n=16) (with mean age 39.3 ± 9.8 years, height 168.1 ± 8.1 cm, body mass 74.2 ± 5.8 kg). Primary outcome included QOL and secondary was LSPS. Both variables were assessed by the WHOQOL-BREF questionnaires and electrogoniameter, respectively. The measurements were performed at baseline, following a 6-week intervention, and after a 4-week follow-up. The ANCOVA test at P < 0.05 was administrated to analyze the collected data using SPSS software. There was a statistically significant difference between experimental groups and the control group to improve QOL. But, no difference was seen regarding the effects of two exercises on LSPS (p < 0.05). Both Pilates and Mackenzie exercises demonstrated improvement in QOL after 6-week intervention and a 4-week follow-up while none of them considerably affected LSPS. Further studies are required to establish a supporting evidence for the effectiveness of two exercises on NSCLBP.

Keywords: pilates, Mackenzie, preconception, low back pain, physical health

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Authors: Drutika Upadhyay

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Rape is one of the most heinous crimes committed against the body of a woman violating her privacy and dignity. The Right to Privacy and the Right to Live with Dignity constitute the very essence of the Right to Life and Personal Liberty, a Fundamental Right guaranteed under Article 21 of the Indian Constitution. The study is conducted with the primary objective of analyzing the efficacy of rape laws in India. The study begins by explaining the origin, meaning, and kinds of rape recognised under Indian jurisprudence. Further, it explains various statutory and penal provisions relating to rape and the loopholes in such provisions. It focuses on the procedure followed during investigation and trial and also aims at developing an understanding of the rights of the victim and the sentence in cases of rape. The study also throws some light upon the amendments made to the criminal law and the recommendations of the Law Commission of India to meet the demands of the changing criminal justice delivery system. The outcome of the study suggests that the laws relating to rape have proved to be a major failure owing to the lack of proper implementation. Also, the lack of education among the masses leads to gender biasness, which is the ultimate cause for the commission of such crime. At last, the author concludes that the present criminal law system of the country contains various lacunae that need to be filled in so as to make the criminal justice system more stringent. Further, the scope of the definition of ‘rape’ needs to be widened in order to include such other acts of non-consensual and sexual nature that are currently not included in the definition. The author has adopted a non-doctrinal and analytical approach and relied upon the secondary sources of data for the purpose of the study. The scope of the study is limited to the crime committed against women.

Keywords: amendment, criminal law, fundamental right, personal liberty, privacy, rape

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Authors: Mohammad Najmol Haque, Takeshi Maki, Jun Sasaki

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Headed stud shear connections are widely used in the junction or embedded zone of hybrid girder to achieve whole composite action with continuity that can sustain steel-concrete interfacial tensile and shear forces. In Japan, Japan Road Association (JRA) specifications are used for hybrid girder design that utilizes very low level of stud capacity than those of American Institute of Steel Construction (AISC) specifications, Japan Society of Civil Engineers (JSCE) specifications and EURO code. As low design shear strength is considered in design of connections, the time dependent shear behavior due to sustained external loading is not considered, even not fully studied. In this study, a finite element approach was used to evaluate the time dependent shear behavior for headed studs used as connections at the junction. This study clarified, how the sustained loading distinctively impacted on changing the interfacial shear of connections with time which was sensitive to lodging history, positions of flanges, neighboring studs, position of prestress bar and reinforcing bar, concrete strength, etc. and also identified a shear influence area. Stud strength was also confirmed through pushout tests. The outcome obtained from the study may provide an important basis and reference data in designing connections of hybrid girders with enhanced stud capacity with due consideration of their long-term shear behavior.

Keywords: finite element, hybrid girder, shear connections, sustained loading, time dependent behavior

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Authors: Pedro Gomes, Lia Ferreira, Sofia Garcia, Jaime Babulal, Luís Costa, Luís Castelo, José Muras, Isabel Gonçalves, Rui Carvalho

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Introduction: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. Objectives: The present study aims to evaluate the outcomes in terms of need for hospitalization, amputation, healing time and mortality in patients with new-onset diabetic foot ulcers in subgroups stratified by etiology. Methods: A retrospective study based on clinical assessment of patients presenting with new ulcers to a multidisciplinary diabetic foot consult during 2012. Outcomes were determined until September 2014, from hospital registers. Baseline clinical examination was done to classify ulcers as neuropathic, ischemic or neuroischemic. Results: 487 patients with new diabetic foot ulcers were observed; 36%, 15% and 49% of patients had neuropathic, ischemic and neuroischemic ulcers, respectively. For analysis, patients were classified as having predominantly neuropathic (36%) or ischemic foot (64%). The mean age was significantly higher in the group with ischemic foot (70±12 vs 63±12 years; p <0.001), as well as the duration of diabetes (18±10 vs 16 ± 10years, p <0.05). A history of previous amputation was also significantly higher in this group (24.7% vs 15.6%, p <0.05). The evolution of ischemic ulcers was significantly worse, with a greater need for hospitalization (27.2% vs 18%, p <0.05), amputation (11.5% vs 3.6% p <0.05) mainly major amputation (3% vs. 0%; p <0.001) and higher mean healing time (151 days vs 89 days, p <0.05). The mortality rate at 18 months, was also significantly higher in the ischemic foot group (7.3% vs 1.8%, p <0.05). Conclusions: All types of diabetic foot ulcers are associated with high morbidity and mortality, however, the presence of arterial disease confers a poor prognosis. Diabetic foot can be successfully treated only by the multidisciplinary team which can provide more comprehensive and integrated care.

Keywords: diabetes, foot ulcers, etiology, outcome

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Authors: Ratna Farida Soenarto, Anas Alatas, Made Ryan Kharmayani

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Background: Conventional ultrafiltration (CUF) system was shown to be helpful in reducing anti-inflammatory mediators for patients who underwent open heart surgery. Additionally, modified ultrafiltration (MUF) has been shown to reduce anti-inflammatory mediators further while reducing interstitial fluid volume at the same time. However, there has been minimal data concerning the efficacy of combining both ultrafiltration methods. This study aims to compare inflammation marker, vascular resistance, and cardiac index on CUF+MUF patients with CUF only patients undergoing open heart surgery. Method: This is a single blind randomized controlled trial on patients undergoing open heart surgery between June 2021 - October 2021 in CiptoMangunkusumo National Referral Hospital and Jakarta Heart Hospital. Patients wererandomized using block randomization into modified ultrafiltration following conventional ultrafiltration (CUF+MUF) and conventional ultrafiltration (CUF) only. Outcome assessed in this study were 24-hoursinterleukin-6 levels, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), and cardiac index. Results: A total of 38patients were included (19 CUF+MUF and 19 CUF subjects). There was no difference in postoperative IL-6 level between groups (p > 0.05).No difference in PVR was observed between groups.Higher difference in SVR was observed in CUF+MUF group (-646 vs. -261dyn/s/cm-5, p < 0.05). Higher cardiac index was observed on CUF+MUF group (0.93 vs. 0.48, p < 0.05). Conclusion: Patients undergoing open heart surgery with modified ultrafiltration following conventional ultrafiltration had similar systemic inflammatory response and better cardiac response than those having conventional ultrafiltration.

Keywords: open-heart, CUF, MUF, SVR, PVR, IL-6

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Authors: Thanakorn Thanawat, Nomjit Nualnetr

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Background and Purpose: In Thailand, rice farmers have the most prevalence of low back pain when compared with other manual workers. Exercises have been suggested to be a principal part of treatment programs for low back pain. However, the programs should be tailored to an individual’s readiness to change categorized by a behavioral approach. This study aimed to evaluate a difference between the responses of rice farmers with chronic low back pain who received an exercise program integrated with the transtheoretical model of behavior change (TTM) and those of the comparison group regarding severity of pain and trunk muscle endurance. Materials and Methods: An 8-week exercise program was conducted to rice farmers with chronic low back pain who were randomized to either the TTM (n=62, 52 woman and 10 men, mean age ± SD 45.0±5.4 years) or non-TTM (n=64, 53 woman and 11 men, mean age ± SD 44.7±5.4 years) groups. All participants were tested for their severity of pain and trunk (abdominal and back) muscle endurance at baseline (week 0) and immediately after termination of the program (week 8). Data were analysed by using descriptive statistics and student’s t-tests. The results revealed that both TTM and non-TTM groups could decrease their severity of pain and improve trunk muscle endurance after participating in the 8-week exercise program. When compared with the non-TTM group, however, the TTM showed a significantly greater increase in abdominal muscle endurance than did the non-TTM (P=0.004, 95% CI -12.4 to -2.3). Conclusions and Clinical Relevance: An exercise program integrated with the TTM could provide benefits to rice farmers with chronic low back pain. Future studies with a longitudinal design and more outcome measures such as physical performance and quality of life are suggested to reveal further benefits of the program.

Keywords: chronic low back pain, transtheoretical model, rice farmers, exercise program

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Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi

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Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.

Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate

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Authors: Muhammad Izzam Bin Mohd Khazar, Ruqayyah Binti Mohamad Ali, Nurul Atiqah Binti Yusri

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Value-based intermediation (VBI) has been introduced by Bank Negara Malaysia (BNM) as the next strategic direction and growth driver for Islamic banking institutions. The aim of VBI is to deliver the intended outcome of Shariah through practices, conducts, and offerings that generate positive and sustainable impact to the economy, community and environment which is aligned to Maqasid Shariah in preserving the common interest of society by preventing harm and maximizing benefit. Hence, upon its implementation, VBI will experiment the current Shariah compliance treatment and revolutionise new policies and systems that can meritoriously entrench and convey the objectives of Shariah. However, discussion revolving VBI in the light of Maqasid analysis is still scarce hence further research needs to be undertaken. The idea of implementation of VBI vision into quantifiable Maqasid Shariah measurement is yet to be explored due to the nature of Maqasid that is variable. The contemporary scholars also have different views on the implementation of VBI. This paper aims to discuss on the importance of Maqasid Shariah in the current Islamic finance transactions by providing Shariah index measurement in the application of VBI. This study also intends to explore basic Shariah guidelines and parameters based on the objectives of Shariah; preservation of the five pillars (religion, life, progeny, intellect and wealth) with further elaboration on preservation of wealth under five headings: rawaj (circulation and marketability); wuduh (transparency); hifz (preservation); thabat (durability and tranquillity); and ‘adl (equity and justice). In alignment with these headings, Islamic finance can be innovated for VBI implementation, particularly in Maybank Islamic being a significant leader in the IFI market.

Keywords: Islamic Financial Institutions, Maqasid Index, Maqasid Shariah, sustainability, value-based intermediation

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Authors: Repaul Kanji, Rajat Agrawal

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In this era where issues like climate change and disasters are the topics of discussion at national and international forums, it is very often that humanity questions the causative role of corporates in such events. It is beyond any doubt that rapid industrialisation and development has taken a toll in the form of climate change and even disasters, in some case. Thus, demanding to fulfill a corporate's responsibilities in the form of rescue and relief in times of disaster, rehabilitation and even mitigation and preparedness to adapt to the oncoming changes is obvious. But how can the responsibilities of the corporates be channelised to ensure all this, i.e., develop a resilient society? More than that, which factors, when emphasised upon, can lead to the holistic development of the society. To answer this query, an extensive literature review was done to identify several enablers like legislations of a nation, the role of brand and reputation, ease of doing Corporate Social Responsibility, mission and vision of an organisation, religion and culture, etc. as a tool for building disaster resilience. A questionnaire survey, interviews with experts and academicians followed by interpretive structural modelling (ISM) were used to construct a multi-hierarchy model depicting the contextual relationship among the identified enablers. The study revealed that culture and religion are the most powerful driver, which affects other enablers either directly or indirectly. Taking cognisance of the fact that an idea of separation between religion and workplace (business) resides subconsciously within the society, the study tries to interpret the outcome of the ISM through the lenses of past researches (The Integrating Box) and explores how it can be leveraged to build a resilient society.

Keywords: corporate social responsibility, interpretive structural modelling, disaster resilience and risk reduction, the integration box (TIB)

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Authors: Lauren McGillivray, Michelle Torok, Alison Calear

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Suicide is the leading cause of death for Australians aged 15-24 years, with rates increasing over the past decade. As young people can be particularly vulnerable to mental health problems and suicidal behavior, they are an essential and obvious target for suicide prevention efforts. This study investigates the effectiveness of the universal mental health promotion and suicide prevention program, Youth Aware of Mental Health (YAM), to reduce suicidal ideation and attempts and increase help-seeking in young people. This trial took place in Australian schools across four regions in New South Wales that form part of LifeSpan, a larger multilevel suicide prevention research trial. The YAM program was delivered to Year 9 students in up to 78 schools over two years (from January 2017 to December 2019). All schools were invited to participate in YAM's evaluation, which included completing a student questionnaire at three time-points: baseline, 3-month post-intervention, and 6-month follow-up. The primary outcome is suicidal ideation severity. Secondary outcomes are new reports of suicide attempts, stigma towards suicide, knowledge about suicide, help-seeking intentions and behaviors, and depressive symptoms. Results from pre-post and follow-up data will be presented. These research findings are promising and will contribute to the evidence-based for YAM and suicide prevention programs in Australian schools. These findings are also expected to promote YAM's value and sustainability to be more widely delivered in Australian secondary schools.

Keywords: adolescent mental health, suicidal ideation, suicide prevention, universal program

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Authors: Syed Toqueer Akhter, Muhammad Muzaffar Abbas

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Conflicts in Pakistan are a result of a configuration of factors, which are directly related to the system of the state, the unstable regional setting, and the geo-strategic location of Pakistan at large. This paper examines the impact of regional conflict onto the socio-political sustainability of Pakistan. The magnitude of the spillover from a conflicted region is similar in size of the equivalent increase in domestic conflict. Pakistan has gone at war three times with India; the border with India is named as the tensest borderlines of the world. Disagreements with India and lack of dispute settlement mechanisms have negatively effected the peace in the region, influx of illegal weapons and refugees from Afghanistan as an outcome of 9/11 incidence, have exasperated the criticality of levels of internal conflict in Pakistan. Our empirical findings are based on the data collected on regional conflict levels, regional trade, global trade, comparative defence capabilities of the region in contrast to Pakistan and the government regime (Autocratic, Democratic) over 1972-2007. It has been proposed in this paper that the intent of domestic conflict is associated with the conflict in the region, regional trade, global trade and the government regime of Pakistan. The estimated model (OLS) implies that domestic conflict is effected positively and significantly with long term impact of conflict in the region. Also, if defence capabilities of the region are better than that of Pakistan it effects domestic conflict positively and significantly. Conflict in neighbouring countries are found as a source of domestic conflict in Pakistan, whereas the regional trade as well as type of government regimes in Pakistan lowered the intensity of domestic conflict significantly, while globalized trade imply risk of domestic conflict to be reduced but not significantly.

Keywords: conflict, regional trade, socio-politcal instability

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Authors: Diego A. Romero Espinosa

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Thermal simulations are used to evaluate comfort and energy consumption of buildings. However, the performance of different urban forms cannot be assessed precisely if an environmental control system and user schedules are considered. The outcome of such analysis would lead to conclusions that combine the building use, operation, services, envelope, orientation and density of the urban fabric. The influence of these factors varies during the life cycle of a building. The orientation, as well as the surroundings, can be considered a constant during the lifetime of a building. The structure impacts the thermal inertia and has the largest lifespan of all the building components. On the other hand, the building envelope is the most frequent renovated component of a building since it has a great impact on energy performance and comfort. Building services have a shorter lifespan and are replaced regularly. With the purpose of addressing the performance, an urban form, a specific orientation, and density, a thermal simulation method were developed. The solar irradiation is taken into consideration depending on the outdoor temperature. Incoming irradiation at low temperatures has a positive impact increasing the indoor temperature. Consequently, overheating would be the combination of high outdoor temperature and high irradiation at the façade. On this basis, the indoor temperature is simulated for a specific orientation of the evaluated urban form. Thermal inertia and building envelope performance are considered additionally as the materiality of the building. The results of different thermal zones are summarized using the 'Degree day method' for cooling and heating. During the early phase of a design process for a project, such as Masterplan, conclusions regarding urban form, density and materiality can be drawn by means of this analysis.

Keywords: building envelope, density, masterplanning, urban form

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Authors: L. Petrosyan

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The problem of psychologist training remains a key priority in Armenia. During the Soviet period, the notion of a psychologist was obscure not only in Armenia but also in other Soviet republics. The breakup of the Soviet Union triggered a gradual change in this area activating the cooperation with specialists from other countries. The need for recovery from the psychological trauma caused by the 1988 earthquake pushed forward the development of practical psychology in Armenia. This phenomenon led to positive changes in perception of and interest to a psychologist profession.Armenian universities started designing special programs for psychologists’ preparation. Armenian psychologists combined their efforts in the field of training relevant specialists. During the recent years, the Bologna educational system was introduced in Armenia which led to implementation of education quality improvement programs. Nevertheless, even today the issue of psychologists’ training is not yet settled in Armenian universities. So far graduate psychologists haven’t got a clear idea of personal and professional qualities of a psychologist. Recently, as a result of educational reforms, the psychology curricula underwent changes, but so far they have not led to a desired outcome. Almost all curricula in certain specialties are aimed to form professional competencies and strengthen practical skills. A survey conducted in Armenia aimed to identify what are the ideas of young psychology specialists on the image of a psychologist. The survey respondents were 45 specialists holding bachelor’s degree as well as 30 master degree graduates, who have not been working yet. The research reveals that we need to change the approach of preparing psychology practitioners in the universities of Armenia. Such an approach to psychologist training will make it possible to train qualified specialists for enhancement of modern psychology theory and practice.

Keywords: practitioners, psychology degree, study, professional competencies

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Authors: G. Ramya

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Value engineering is a systematic approach, widely used to optimize the design or process or product in the designing stage. It used to achieve the client's obligation by increasing the functionality and attain the targeted cost in the cost planning. Value engineering effectiveness and benefits decrease along with the progress of the project since the change in the scope of the work and design will account for more cost all along the lifecycle of the project. Integrating the value engineering with other project management activities will promote cost minimization, client satisfaction, and ensure early completion of the project in time. Previous research studies suggested that value engineering can integrate with other project delivery activities, but research studies unable to frame a model that collaborates the project management activities with the job plan of value engineering approach. I analyzed various project management activities and their synergy between each other. The project management activities and processes like a)risk analysis b)lifecycle cost analysis c)lean construction d)facility management e)Building information modelling f)Contract administration, collaborated, and project delivery model planned along with the RIBA plan of work. The key outcome of the research is a value-driven project delivery model, which will succeed in dealing with the economic impact, constraints and conflicts arise due to the COVID-19 outbreak in the Indian construction sector. Benefits associated with the structured framework is construction project delivery that ensures early contractor involvement, mutual risk sharing, and reviving the project with a cost overrun and delay back on track ,are discussed. Keywords: Value-driven project delivery model, Integration, RIBA plan of work Themes: Design Economics

Keywords: value-driven project delivery model, Integration, RIBA

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Authors: Terentes Printzios Dimitrios, Loanna Gourgouli, Vlachopoulos Charalambos

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Aims: Atrial fibrillation (AF) remains one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity. Ablation techniques are becoming more appealing after the latest results of randomized trials showing the overall clinical benefit. On the other hand, imaging techniques and the frontier application of 3D printing are emerging as a valuable ally for cardiac procedures. However, no randomized trial has directly assessed the impact of preprocedural imaging and especially 3D printing guidance for AF ablation. The present study is designed to investigate for the first time the effect of 3D printing of the heart on the safety and effectiveness of the ablation procedure. Methods and design: The 3D-GALA trial is a randomized, open-label, controlled, multicentre clinical trial of 2 parallel groups designed to enroll a total of 100 patients undergoing ablation using cryo-balloon for paroxysmal and persistent AF. Patients will be randomized with a patient allocation ratio of 1: 1 to preprocedural MRI scan of the heart and 3D printing of left atrium and pulmonary veins and cryoablation versus standard cryoablation without imaging. Patients will be followed up to 6 months after the index procedure. The primary outcome measure is the reduction of radiation dose and contrast amount during pulmonary veins isolation. Secondary endpoints will include the percentage of atrial fibrillation relapse at 24h-Holter electrocardiogram monitoring at 6 months after initial treatment. Discussion: To our knowledge, the 3D-GALA trial will be the first study to provide evidence about the clinical impact of preprocedural imaging and 3D printing before cryoablation.

Keywords: atrial fibrillation, cardiac MRI, cryoablation, 3-d printing

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